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Does anyone have experience with using Nitrolingual Spray directly
applied to the chest wall prn pain? The MD who ordered this says
it works. Any information would be greatly appreciated.
Thanks,
Carol Carson, R.Ph.
--
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Have not heard of topically to the chest wall. Have seen it used topically
over the intended site of IV access to give a larger vessel into which to
stick the catheter.
Sorry for the tangential comment.
Greg Soon
Pharmacist - ICU/Surgery
Peterborough Civic Hospital
Peterborough, ON, Canada
(705) 876-5083
(705) 876-5110 (fax)
gsoon.-a-.sympatico.ca
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Spent a few minutes on MEDLINE and came up with
these two references regarding transdermal ISDN spray.
[1] Orv Hetil 1994 Oct 30;135(44):2421-2423
Antianginal effect of transdermal isosorbide dinitrate.
[Article in Hungarian]
Kekes E
Haynal Imre Egeszsegtudomanyi Egyetem, Budapest, II. sz.
Belgyogyaszati Klinika.
Efficacy of **transdermal isosorbid-dinitrate spray** was investigated in
167 of 254 patients with stable angina pectoris. The transdermal
application of isosorbid-dinitrate decreased successfully the number
of anginal attacks and the sublingual nitroglycerin or
isosorbid-dinitrate consumption. Very few side effects were observed
and the patients well-being was good during treatment.
[2] Vnitr Lek 1989 Aug;35(8):758-764
Clinical effects of isosorbide dinitrate in the transdermal spray (TD
Spray Iso Mack) form. [Article in Czech]
Vitovec J, Stejfa M, Blaha M, Nemcova H, Roubalik P, Spac J
The authors report on their experience with the transdermal spray, TD
spray Iso Mack. Using a graded ergometric test, the authors examined
11 patients with angina on exertion before and 60 minutes after
administration of 60 mg of the effective substance by the transdermal
route. The average threshold of ischaemia and work tolerance increased
significantly and the ECG depression of segment S-T receded. In an
open trial six patients were investigated with angina on exertion
during three-week treatment with the spray--twice a day 60 mg by the
transdermal route--as compared with standard treatment. The number of
attacks and consumption of sublingual nitroglycerin decreased
significantly. Five patients were subjected to haemodynamic
examination before and repeatedly after application of 60 mg of the
spray. A significant drop of the filling pressures occurred which
persisted for 6 to 8 hours.
********************************
Randy Trinkle, BScPharm, BA
Dept. of Pharmacy
Dawson Creek & District Hospital
Dawson Creek, BC
mailto://rtrinkle.at.pris.bc.ca
********************************
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I would expect it to be absorbed sprayed on any convenient patch of
skin. Whether it is effecive depends on the dose...
Mainly for marketing reasons the recommended application sites follow
the layperson's model of the body not the anatomically guided
pharmacokineticist's.
ie. testosterone patches are applied to the scrotum
nitroglycerine patches for angina to the chest wall
oestrogen patches to prevent (hip?) fractures to the gluteal region
scopolamine patches for vertigo behind the ear
Look out for tacrine patches applied to the forehead :-)
--
Nick Holford, Dept Pharmacology & Clinical Pharmacology
University of Auckland, Private Bag 92019, Auckland, New Zealand
email:n.holford.-a-.auckland.ac.nz tel:+64(9)373-7599x6730 fax:373-7556
http://www.phm.auckland.ac.nz/Staff/NHolford/nholford.html
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Hi,
These look like good references, but they refer to "transdermal spray" (and
isosorbide dinitrate spray), which I don't thing is necessarily synonymous
to Nitrolingual Spray - which delivers 0.4mg of nitroglycerin per spray.
If you compare the amount of nitroglycerin in transdermal patches that it
takes to deliver a particular amount of nitroglycerin (up to 62.5mg in some
patches to deliver only 5mg of NTG in 24hrs), there is obviously incomplete
absorption transdermally, so it seems that you would need far more than one
spray of Nitrolingual applied topically to deliver a therapeutic dose. I
think I'd really have trouble going along with such an order without seeing
some kind of article to back it up, especially when there so many
alternatives.
Bob Meyer, RPh
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> If you compare the amount of nitroglycerin in transdermal patches that it
> takes to deliver a particular amount of nitroglycerin (up to 62.5mg in some
> patches to deliver only 5mg of NTG in 24hrs), there is obviously incomplete
> absorption transdermally
I think it is more accurately described as incomplete release. As I
understand the technology of most patch devices they generally only
deliver a fraction (20%?) of the dose in the time they are applied. This
is one way to mimic a zero-order delivery system i.e. the transfer from
patch to skin may well be first-order but given that the amount in the
patch only changes by say 20% the delivery rate is approximately the
same (within 20%) over the delivery interval.
--
Nick Holford, Dept Pharmacology & Clinical Pharmacology
University of Auckland, Private Bag 92019, Auckland, New Zealand
email:n.holford.-a-.auckland.ac.nz tel:+64(9)373-7599x6730 fax:373-7556
http://www.phm.auckland.ac.nz/Staff/NHolford/nholford.html
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Bob, I agree. I did a quick swipe through MEDLINE to see if
*anything* had been published about a nitrate/NTG spray. The doses
mentioned in the abstracts make me suspect that the concentration
of drug in the spray must be higher--not familiar with the product.
> it seems that you would need far more than one
> spray of Nitrolingual applied topically to deliver a therapeutic dose.
I would think so too, but I'd like to see if it would work. Even
if it did, what would be the advantage? The mechanics of giving
it this way would seem to argue against simply opening one's mouth.
> think I'd really have trouble going along with such an order without seeing
> some kind of article to back it up, especially when there so many
> alternatives.
I'd still be curious if it would work--making sure s/l was the
backup.
Cheers.
********************************
Randy Trinkle, BScPharm, BA
Dept. of Pharmacy
Dawson Creek & District Hospital
Dawson Creek, BC
mailto://rtrinkle.-at-.pris.bc.ca
********************************
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Copyright 1995-2010 David W. A. Bourne (david@boomer.org)